Faizi Siddiqi

Role of antibiotics in acute pancreatitis: A meta-analysis

In an attempt to decrease the infectious complications of acute pancreatitis and its high mortality, many investigators have conducted randomized prospective trials on the efficacy of prophylactic antibiotics. The results of these studies are conflicting, and many have called for a large multicenter study. Because multicenter trials are costly and difficult to organize, we believe that meta-analysis is a reasonable alternative. A meta-analysis of all eight previously published trials of prophylactic antibiotics in acute pancreatitis was performed. The end point was death. The Mantel-Haenszel statistic was used to summarize odds ratios across studies in a fixed effects model, after homogeneity was assessed. Sensitivity analysis was performed as appropriate. The meta-analysis of all eight trials showed a positive benefit for antibiotics in reducing mortality. Sensitivity analysis showed that the advantage was limited to patients with severe pancreatitis who received broad-spectrum antibiotics that achieve therapeutic pancreatic tissue levels. It is recommended that all patients with severe pancreatitis be treated with broad-spectrum antibiotics that achieve therapeutic levels in pancreatic tissue.

Deformational Plagiocephaly : Development of an Objective Measure and Determination of its Prevalence in Primary Care

Referrals for deformational plagiocephaly (DP) have increased, but estimates of its actual prevalence vary, depending on the population studied and criteria for diagnosis. Few studies employ an objective technique for diagnosis. The objectives of this study were to validate the Transcranial Diameter Difference (TDD) and, using it, determine the prevalence of DP among infants seen by primary care pediatricians. We determined the TDD of 32 infants referred to a craniofacial clinic for DP; blinded to the TDD a craniofacial surgeon assigned a DP severity score. We compared the TDD and severity scores. The TDD of 192 infants presenting to primary care practices (PCP) were determined and their parents completed a DP risk factor questionnaire. Odds ratios for associations of risk factors with DP were calculated. The correlation between TDD and DP severity score was 0.61 (P = 0.002). All infants whose TDD > 0.6 cm had a severity score > 2; 18.2% of the 192 infants had DP as defined by a TDD > 0.6 cm. Significant odds ratios (95% confidence intervals) for the presence of DP were sleeping supine, 3.5; (1.6, 7.5), and infant head position preference 2.2; (1.0, 4.9). Varying the sleep position decreased the risk of DP, OR = 0.40 (0.2, 0.9). We conclude that the TDD is a valid, objective measure of DP for use in research studies. DP is present in nearly one in five PCP infants. Because an infant who prefers to hold his head in one position is more likely to have DP, advising parents to vary the head position may reduce the risk of DP.

Early exercise after experimental myocardial infarction: effect on left ventricular remodeling

BackgroundThe effect of exercise on left ventricular remodeling after myocardial infarction is unclear. The purpose of this investigation was to test whether exercise undertaken during the healing phase of an acute myocardial infarction has an adverse effect on left ventricular remodeling. MethodsBefore surgery, rats (n = 94) were allocated randomly to one of four groups: 1) infarct, swimming exercise; 2) infarct, no exercise; 3) sham operation, swimming exercise; 4) sham operation, no exercise. Beginning 1 week after infarction or sham operation, the rats in the exercise groups swam twice daily for 2 weeks. After a deconditioning period of 5 days, the rats were re-anesthetized, hemodynamic measurements were made, and the hearts were fixed for morphometric analysis. ResultsSwimming exercise had no effect on remodeling of infarcted myocardium. Rats with infarcts in the swimming and no exercise groups had similar infarct thicknesses (1.1 ± 0.2 mm and 0.8 ± 0.2 mm respectively; NS), and similar degrees of infarct expansion (expansion index 1.2 ± 0.3 and 1.4 ± 0.3 respectively; NS). Swimming exercise also had no effect on remodeling of non-infarcted myocardium. Left ventricular volumes and pressure–volume relationships were similar in exercised and non-exercised infarcted rats. ConclusionIn rats, 2 weeks of swimming exercise, started 1 week after acute experimental myocardial infarction and followed by 5 days of deconditioning, does not have an adverse effect on left ventricular remodeling.

Minimally invasive strip craniectomy for sagittal synostosis.

Abstract The most common approaches used today for the correction of sagittal synostosis involve large craniectomies and extensive cranial vault remodeling. Although these techniques ultimately yield very good cosmetic results, they have significant drawbacks. They are lengthy, expensive, associated with significant blood loss, universally require transfusions, and often result in prolonged hospitalization. We present here our 5-year experience with correction of sagittal synostosis using the recently described minimally invasive strip craniectomy followed by postoperative cranial vault helmet molding. During this period, we treated a total of 97 children with nonsyndromic single-suture synostosis. The first 46 of 67 children treated for sagittal synostosis had at least 1 year of postoperative follow-up and were included in the analysis. There were 33 boys and 13 girls. Patients’ mean age at surgery was 3.1 months, and the mean weight was 6.1 kg. The mean operative time was 75 minutes. The estimated blood loss during the procedure was 56 mL. Eight patients received blood transfusions during surgery (17.4%) and 3 patients received after surgery (6.5%). There were no significant postoperative complications. The mean hospitalization was 2.2 days. Excellent aesthetic outcomes were noted in all patients. The change in cranial index from a preoperative value of 0.7 to 0.8 postoperatively was virtually stabilized 3 months after the surgical intervention. Significantly better correction rates were observed in the youngest patients. Because of its excellent attributes, minimally invasive strip craniectomy followed by postoperative helmet molding is likely to become the preferred treatment modality for the correction of sagittal synostosis.

Management of Deep Wound Complications With Vacuum-Assisted Therapy After Berlin Heart EXCOR Ventricular Assist Device Placement in the Pediatric Population

Wound complications after ventricular assist device (VAD) placement remain a formidable challenge to surgeons. The Berlin Heart EXCOR VAD is a versatile pulsatile system that has been successful in pediatric patients of all ages and sizes. Prevention of device-related complications such as infection, particularly in pediatric patients, remains an essential issue in minimizing patient morbidity and mortality. The introduction of vacuum-assisted wound closure (VAC) therapy and its application in VAD-related wound complications provide an efficient and effective method for wound healing. We report our experience in the management of deep wound complications in two pediatric patients after placement of the Berlin Heart EXCOR VAD. The wound VAC system proved to achieve complete wound healing without any infectious complications.

Attenuation of Acute Lung Injury Caused by Hind-Limb Ischemia-Reperfusion Injury by Butyrolactone Anti-inflammatory Agent FL1003

OBJECTIVE Activation of systemic inflammation after reperfusion of ischemic tissue results in severe acute lung injury. Neutrophil activation and oxygen radical generation have been implicated in the pathogenesis. This study tested the hypothesis that treatment with FL1003, a butyrolactone with in vitro antioxidant properties, will down-regulate this response and abrogate acute lung injury. METHODS Male Sprague-Dawley rats (n = 16) were divided into a surgical sham group (n = 4), a group that received 2 hours of ischemia by infrarenal aortic clip followed by 1 hour of reperfusion (n = 7), and an ischemia-reperfusion (I/R) group that received FL1003 100 mg/kg intravenously before ischemia (n = 5). After reperfusion, the heart and lungs were excised en bloc in an isolated lung perfusion apparatus for 1.5 hours of perfusion, while pulmonary artery pressures were held between 5 and 12 mm Hg and venous effluent was collected. Bronchoalveolar lavage fluid and both lungs were harvested at death for determination of tissue water content, pulmonary microvascular permeability, and indicators of neutrophil activation and tissue oxidation. RESULTS After I/R, there were significant (p < 0.05) increases in intravenous fluid (IVF) requirements (18 +/- 1.2 mL) to maintain hemodynamic stability, wet weight/dry weight ratio of lung tissue, and isolated-lung lavage Ficoll concentrations (0.58 +/- 0.02 microg/mL) compared with sham animals (IVF, 0 mL; Ficoll concentration, 0.08 +/- 0.03 microg/mL). In addition, lung myeloperoxidase activity (0.60 +/- 0.03 vs. 0.12 +/- 0.02 units/g of tissue) and levels of lipid-conjugated dienes (0.042 +/- 0.012 vs. 0.018 +/- 0.006 optical density of 233 nm (OD233)/mL) were significantly higher (p < 0.05) compared with the sham group. In I/R animals treated with FL1003, the IVF requirement (8.5 +/- 1.0 mL), wet weight/dry weight ratio, lung tissue Ficoll concentration (0.21 +/- 0.02 microg/mL), myeloperoxidase concentration (0.217 +/- 0.02 units/g), and lipid-conjugated diene levels (0.012 +/- 0.005 OD233/ mL) were all significantly lower (p < 0.05) than after untreated I/R. CONCLUSION A pulmonary microvascular permeability defect with pulmonary edema, neutrophil aggregation, and cell membrane damage resulted from ischemia and reperfusion. Treatment of animals with FL1003 significantly attenuated the inflammatory response associated with acute lung injury.

Acquired protein S and antithrombin III deficiency caused by nephrotic syndrome: an unusual cause of graft thrombosis.

Thrombotic phenomena are well-recognized complications of nephrotic syndrome attributable to loss of intermediate-sized antithrombotic proteins in the urine, resulting in a hypercoaguable state. As such, nephrotic syndrome may be associated with a reduction in circulating antithrombin III and free protein S levels. Associated spontaneous thrombotic complications are generally venous in nature, with arterial thrombosis occurring less frequently. Hypercoagulability caused by acquired nephrotic syndrome has not generally been recognized as a cause of acute thrombosis of arterial bypass grafts. We report two patients who after having nephrotic syndrome sustained acute thrombosis of their arterial bypass grafts. Pathogenesis and management are discussed.

Endoscopic-assisted correction of metopic synostosis.

AbstractOur 6-year experience with correction of metopic synostosis using a minimally invasive endoscopic-assisted technique followed by postoperative cranial vault helmet molding is presented. In addition, a simple, objective method for quantification of the frontal vault contour is described.A total of 16 patients, 13 males and 3 females, with nonsyndromic, single-suture synostosis were included in the study. Patient age at operation averaged 2.9 months and the mean weight was 6 kg. The mean operative time was 79 minutes. The estimated blood loss during the procedure was 82.8 mL. Three patients required blood transfusions (18.7%). There were no significant postoperative complications. The mean hospitalization was 1.6 days. The average surgical cost, including the helmets, was

Surgical Excision of Non-Melanoma Skin Cancer in an Elderly Veteran's Affairs Population.

12,400, in contrast to

Minimizing bone gaps when using custom pediatric cranial implants is associated with implant success

33,000 charged for the equivalent open procedure.Very good esthetic results, judged by physical examination and photograph comparison, were obtained in all patients. No relapses were noted. Objectively, the outcome of the operative repair was evaluated using laser scanning. For quantification of the distortion and the postoperative level of correction, the metopic angle was defined and used. This angle changed from preoperative value of 104.9 degrees to 111.3 degrees at 3 months (P = 1.59E−06) and to 114.9 degrees at 1 year postoperatively (P = 2.51E−09).Due to its promising attributes, minimally invasive strip craniectomy emerges as an ideal modality for correction of metopic synostosis. Furthermore, the metopic angle should provide clinicians with an objective measure of the frontal cranial vault deformity and its correction.